Doctor insights on:
Proximal Renal Tubular Acidosis

1

Renal Replacement Th:
Dialysis is one of the treatments for metabolic acidosis. Depending on the cause as well as the other medical problems and type of the acidosis, correcting the inciting problem is the first step dialysis may or may not be needed.
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Normally our body chemistry is kept in a narrow range, and in particular the amount of acid in the body is kept within a narrow range. The amount of acid is measured by a value called the ph. It is normally a value between 7.35 and 7.45, values below 7.35 are considered to be "acidotic" a patient with this value of the blood chemistry would have an "acidosis".
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2

Bone disease:
People with renal failure develop weaken bones from abnormal mineralization of the bone. Renal osteodystrophy is the name of this process where calcium and phosphorus do not deposit into the bone correctly and therefore the person's bones are prone to fractures.
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4

Acidosis:
The simple answer is yes. However, the amount of acid has to be very high for that to happen. High amounts of acid in the blood interfere with many, if not all, biologic processes in the human body such as the effect of Insulin lowering blood sugar, the normal metabolism of proteins and fats that are essential for life, and even normal heart beat, just to name a few.
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5

Tubular neCrosis?:
"nephrosis" is an old name for any kidney disease, but the usual term is tubular necrosis, the anatomic lesion in common temporary kidney failure in which the tubule cells die. They grow back amazingly well most of the time.
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6

Not necessarily:
Only if both the kidneys have to be removed if cancer on both sides. If only one kidney or a part of kidney only is removed and the remaining kidney is healthy dialysis is not required.
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7

Yes:
RTA doesn't cause elevated anion gap, but other disorders that do can be present along with RTA. For example, advanced kidney failure can cause anion gap, and also cause RTA. Usually simple math will show that the anion gap doesn't completely account for the degree of acidosis, and urine tests can demonstrate presence of RTA.
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11

Yes:
Diabetes is the most common cause of permanent kidney failure in most of the world. 40-50% of patients with diabetes will be affected by this complication.
Diabetes also increases the risk of acute kidney injury, particularly following x-rays using intravenous contrast.
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12

Depends:
Many factors contribute to serumpotassium levels including residual kidney function, diuretic use, potassium intake, GI potassium loss (i.e. diarrhea), and acid/base status. It is possible to see high or low serum potassium levels in patients with renal failure but hyperkalemia (high potassium) is more commonly observed in patients with advanced renal dysfunction.
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14

Here are some...:
Acute renal failure is a general term denoting kidneys not able to good enough to manage water and electrolytes due to acute conditions such as shocks from various reasons, and acute tubular necrosis denotes what can be seen in kidney tissue under microscopic exam if biopsy is done, but not necessary for almost all cases. Clinically, they all tell us kidneys not working enough from acute causes.
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15

Not typically:
An ultrasound can suggest radiographic evidence of medical renal disease but cannot diagnose this. To make the diagnosis of renal parenchymal disease the radiographic findings must be combined with blood studies of kidney function and sometimes urine studies for protein or a kidney biopsy.
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16

Not necessarily:
The shrinking of the kidney can lead to decreased kidney function (kidney failure) but there are two kidneys and if one decreased function the other kidney will step up to the task. It needs to be clear why one kidney shrank. This is a guide to the diagnosis and the therapy. Some illness actually cause both kidney to shrink. Your function will help clarify your diagnosis.
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17

Good question:
Chronic renal disease is most often caused by damage to the blood vessels or the glomeruli / filters, leaving the proximal tubular cells able to work on however much filtrate is present.
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18

Multiple kidney cyst:
The vast majority of renal cysts and benign simple cysts which are a symptomatic and causes no problems. It is not the same as polycystic kidney disease, where many cysts on both kidneys could lead to kidney failure. An ultrasound can determine if these are simple vs complex cysts, the latter could be worrisome. I suspect the kind you have could simply be followed over time; urologist will guide.
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